Ketamine

Our rating
1 smiley: This treatment is promising and may be useful. It has some evidence to support it, but more evidence is needed to be sure it works.

What does this rating mean?

The rating system

  • 3 smiliesThese treatments are very useful. They are strongly supported as effective by scientific evidence.
  • 2 smiliesThese treatments are useful. They are supported by scientific evidence as effective, but the evidence is not as strong.
  • 1 smileyThese treatments are promising and may be useful. They have some evidence to support them, but more evidence is needed to be sure they work.
  • No smiley On the available evidence, these treatments do not seem to be effective.
  • Question markThese treatments have not been properly researched. It is not possible to say whether they are useful or not.
  • These treatments are not recommended and could be dangerousSafety or other concerns have been raised for the use of these treatments.

What is it?

Ketamine is an anesthetic medication that is usually used in medical settings to sedate patients. It has been researched as fast-acting antidepressant, usually for patients who don’t respond well to other forms of treatment. Ketamine is also used as an illegal recreational drug.

How does it work?

Ketamine is usually given as an intravenous (IV) fluid by a doctor in hospital. The dose used to treat depression is lower than what would be given to produce anesthetic effects. Ketamine is thought to work by blocking certain receptors in the brain that are involved in cell growth, which may be over-active in people with depression.

Is it effective?

There is some scientific evidence on ketamine for the treatment of depression. While more studies of better quality are needed, the current evidence is promising. Patients who have been given a low-dose of ketamine in hospital often report fast acting (within hours) improvement in their depression symptoms. This in in contrast to typical antidepressant medication, which usually take many weeks to produce an effect. There is no research looking at the long term effectiveness of ketamine.

Are there any disadvantages?

There are some side effects associated with ketamine, which can include feeling dizzy, confused, and out of touch with reality. Currently, ketamine for depression is administered via IV line in a hospital setting and patients have to be monitored for some time afterwards. Ketamine must be given under medical supervision.

Where do you get it?

The use of ketamine as a treatment for depression is still experimental and mostly limited to hospital settings or as part of clinical trials.

Recommendation

More research is needed, but ketamine may be a useful fast-acting antidepressant in the future.

Ketamine is currently classed as a controlled drug in Australia, and unauthorised possession or use may result in criminal penalties.

Key references

  • Aan Het Rot M1, Zarate CA Jr, Charney DS, Mathew SJ. Ketamine for depression: where do we go from here? Biol Psychiatry. 2012 Oct 1; 72(7):5 37-47.
  • Fond G, Loundou A, Rabu C, Macgregor A, Lancon C, Brittner M, et al. Ketamine administration in depressive disorders: a systematic review and meta-analysis. Psychopharmacology. 2014; 231(18): 3663-76.
  • Kraus C, Rabl U, Vanicek T, Carlberg L, Popovic A, Spies M, et al. Administration of ketamine for unipolar and bipolar depression. International Journal of Psychiatry in Clinical Practice. 2017; 21(1): 2-12.
  • Lee EE, Della Selva MP, Liu A, Himelhoch S. Ketamine as a novel treatment for major depressive disorder and bipolar depression: a systematic review and quantitative meta-analysis. General Hospital Psychiatry. 2015; 37(2): 178-84.
  • McGirr A, Berlim MT, Bond DJ, Fleck MP, Yatham LN, Lam RW. A systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials of ketamine in the rapid treatment of major depressive episodes. Psychol Med. 2015 Mar; 45(4): 693-704.
  • Wilkinson ST, Ballard ED, Bloch MH, Mathew SJ, Murrough JW, Feder A, et al. The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis. American Journal of Psychiatry. 2017; 175(2): 150-8.

Last updated and reviewed: 1 November 2019

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